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“Get me off this merry go round”: Barriers to treatment of depression in some adolescent mothers

It came as a shock to me to read that about 500,000 adolescent girls give birth each year in the United States, many of them suffering low levels of income and additionally not covered by private health care insurance.

Very often, it seems, treatment for post-natal depression can be hampered by the new mother's inability to disclose feelings and lack of knowledge about post-natal depression.

According to various studies, adolescents who aren't recent child-bearing have reported many barriers to treatment for depression:

  • a lack of knowledge about where to obtain help;
  • a feeling of stigma about having a mental health disorder and a fear of that being disclosed to peers;
  • a concern that their parents will be notified of their health disorder and the teenagers don't want their parents to know;
  • a lack of transport opportunities to get them to treatment facilities (meaning they may have to ask their parents, and thus be forced to explain what the appointment is for and why they need it);
  • a lack of assistance from their family -- some parents decide that their children don't have a mental health disorder (or are fearful of the inter/intra family, cultural and community stigmas that surround mental health issues) and so where possible do not assist in any treatment and even cancel treatment plans and schedules;
  • prior use of mental health services by the adolescents.

However, no such research into treatment barriers had been conducted on adolescent mothers.

The authors worked with nine teen parents, average age 16 years and racially mixed: four African American, two Caucasian, two Hispanic and one Native American.

Interestingly, none of the mothers used the words "depression" or "postpartum depression"; instead they used words like "crying," "sadness," "anxiety," and "frustration." They also talked about sometimes not having any interest in activities or the baby, not wanting to do anything for themselves, lacking in patience and not being able to put up with everything they have to cope with.

Readily admitting that the tiny sample size and only using one geographic area hampered the 'generalizability' of the results, plus a lack of non-depressed new mothers in the study to act as a possible 'control' group, the authors still reported some interesting findings and make some useful suggestions:

  • finding: the mothers were far more likely to seek help from their boyfriend, mother, sister or other family member before seeking the help of health professionals;
  • finding: additional to the point above, they were more likely to consider going to church and praying, writing their feelings down, getting some sleep, and playing with the baby before seeking professional help;
  • finding: the new mothers were very unprepared for the time-intensive nature of mothering, especially when the child is ill;
  • suggestion: school-based teen parenting programs should include more information on depression, how to recognise it and what to do about it;
  • suggestion: maternal-infant relationship programs should be assessed and introduced into teen parenting programs.

One of the challenges of depression is that it reduces cognitive ability, including language skills -- it becomes harder and harder to express one's feelings, even to identify them accurately, and so seeking professional help is less and less likely to figure in anyone's self-defence repertoire.

When you add in a lack of knowledge about post-natal depression, combined with lack of resource (community support, money, significant suppportive relationships, as examples) and a lack of belief in their ability to cope with a new baby (teens seem to have less belief in their ability to cope than adults, according to one of the study's authors), you have a cocktail of negative influences that can work against the already-stressed new mother.

This study at least helps to identify some of those influences and suggest ways to overcome them.


Source: Logsdon, M. Cynthia, Hines-Martin, Vicki and Rakestraw, Vivian (2009) 'Barriers to Depression Treatment in Low-Income, Unmarried, Adolescent Mothers in a Southern, Urban Area of the United States', Issues in Mental Health Nursing, 30:7, 451-455

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